# Aspirin Overview
**Aspirin** is a long-established non-steroidal anti-inflammatory drug. It is best known for pain relief, fever reduction, and cardiovascular prevention.
In oncology, it is drawing serious repurposing interest because it affects inflammation, platelet biology, immune surveillance, and tumour signalling at the same time. The strongest current human signal is in **PIK3CA-mutated colorectal cancer**, where aspirin now has **Phase 3** support.
### At a Glance
* **What it is:** An oral NSAID that irreversibly inhibits **COX-1** and **COX-2**
* **Why it matters:** It may reduce tumour-promoting inflammation, metastatic spread, and recurrence risk
* **Best-supported use today:** Investigational adjuvant use in **PIK3CA-mutated colorectal cancer**
* **Strongest evidence:** **Phase 3** trial data in biomarker-selected colorectal cancer
* **Main limitation:** Bleeding risk and uneven benefit across populations
### Why aspirin is studied in oncology
Aspirin sits at the intersection of inflammation, immunity, and metastasis.
Research suggests it may:
* suppress **COX-driven** tumour inflammation
* reduce platelet support for metastatic spread
* enhance anti-tumour immune activity
* affect **p53**, DNA repair, and cell-cycle control
* modulate **Wnt / β-catenin** and related survival pathways
### Clinical Positioning
Current evidence best supports aspirin as an **investigational repurposed adjunct**, not as a replacement for standard cancer therapy.
Its strongest current relevance is in the overlap between:
* biomarker-selected colorectal cancer
* inflammation-linked tumour biology
* anti-metastatic strategy
* low-cost repurposed-drug interest
### Evidence Quality Rating
**3.5/5 — Moderate evidence overall, with stronger support in selected colorectal-cancer subgroups**
This rating reflects a large prevention and mechanistic literature, plus important prospective trial data in biomarker-selected colorectal cancer, but limited definitive oncology use across other tumour types.
### Where to Go Next
* [Evidence Summary](/myhealingcommunity-docs/off-label-drugs-for-cancer/aspirin-in-oncology/evidence-summary.md)
* [Anticancer Mechanisms](/myhealingcommunity-docs/off-label-drugs-for-cancer/aspirin-in-oncology/anticancer-mechanisms.md)
* [Aspirin and Thromboxane A2 (TXA2)](/myhealingcommunity-docs/off-label-drugs-for-cancer/aspirin-in-oncology/anticancer-mechanisms/aspirin-and-thromboxane-a2-txa2.md)
* [Aspirin-Like Compounds](/myhealingcommunity-docs/off-label-drugs-for-cancer/aspirin-in-oncology/aspirin-like-compounds.md)
* [Evidence by Cancer Type](/myhealingcommunity-docs/off-label-drugs-for-cancer/aspirin-in-oncology/aspirin-evidence-by-cancer-type.md)
* [Pharmacokinetics & Dosing](/myhealingcommunity-docs/off-label-drugs-for-cancer/aspirin-in-oncology/pharmacokinetics-and-dosing.md)
* [Safety & Interactions](/myhealingcommunity-docs/off-label-drugs-for-cancer/aspirin-in-oncology/safety-and-interactions.md)
* [Immune Effects](/myhealingcommunity-docs/off-label-drugs-for-cancer/aspirin-in-oncology/immune-effects.md)
* [Sourcing Quality Aspirin](/myhealingcommunity-docs/off-label-drugs-for-cancer/aspirin-in-oncology/sourcing-quality-aspirin.md)
### Key References
Elwood P et al. (2021). Aspirin and cancer survival: a systematic review and meta-analyses of 118 observational studies (\~20% reduction in cancer mortality across 18 cancer types). ecancer 15:1258. [https://doi.org/10.3332/ecancer.2021.1258\[^1\]\[^2\]](https://doi.org/10.3332/ecancer.2021.1258\[%5E1]\[%5E2])
Cuzick J et al. (2024). Aspirin and cancer treatment: systematic reviews and meta-analyses of evidence for and against. British Journal of Cancer 130:1–15. [https://doi.org/10.1038/s41416-023-02506-5\[^3\]\[^4\]](https://doi.org/10.1038/s41416-023-02506-5\[%5E3]\[%5E4])
Li Y et al. (2025). Effect of aspirin use on cancer incidence and mortality: a meta-analysis. Public Health 248:105924. [https://pubmed.ncbi.nlm.nih.gov/40865396/\[^5\]](https://pubmed.ncbi.nlm.nih.gov/40865396/\[%5E5])
Li K et al. (2025). Long-term use of low-dose aspirin for cancer prevention (population study: 538,147 aspirin users, SHR 0.92 for cancer risk; SHR 0.80 for cancer mortality). Cancer Medicine 14(1). [https://pmc.ncbi.nlm.nih.gov/articles/PMC12008822/\[^6\]](https://pmc.ncbi.nlm.nih.gov/articles/PMC12008822/\[%5E6])
Drew DA et al. (2021). Evaluation of Aspirin Use With Cancer Incidence and Survival (PLCO trial cohort, 139,896 participants). JAMA Network Open 4(1):e2033622. [https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2775219\[^7\]](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2775219\[%5E7])
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